HomeMy WebLinkAbout973364RECEIVED 9/20/2013 at 3:35 PM
RECEIVING 973364
BOOK: 820 PAGE: 856
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
(Top 3 inches reserved for recording data)
AFFIDAVIT OF IDENTITY AND SURVIVORSHIP Wyoming Uniform Conveyancing Blanks
State of Wyoming, County of LINCOLN Name of Decedent: Alan K. Beck
Form 50.2i (2011)
I, Ida M. Beck being first duly sworn, on oath state from personal knowledge:
1. That Decedent is the person named in the certified copy of the Certificate of Death attached
hereto and made a part hereof.
2. That the name(s) of the survivor(s) is are: Ida M. Beck
3. That on the date of death, Decedent was an owner as a joint tenant /life tenant of the land legally
described as follows:
Check here if all or part of the described real property is Registered (Torrens)
as shown by instrument recorded on 6/20/2006, as Document Number 919509 (or in Book 623 of Page
865), in the Office of the County Recorder Registrar of Titles of LINCOLN County, Wyoming. (If filed
with the Registrar of Titles, insert the Certificate of Title number
Affiant
C--,,a?k? (2i-ie
(signature)
0856
Page 1 of 2
Page 2 of 2
Signed and
Wvorning Uniform Conveyancing Blanks Form 50.2.2
sworn to before me on by Y i g,0/ 3
jOta 7/1. &eld-
(Stamp)
THIS INSTRUMENT WAS DRAFTED BY:
NSS MI
1591 Galbraith Avenue, Suite 200
Grand Rapids, MI 49546
7920068n
Title (and Rank):
/1,Sit,A_/
My commission expires: “0/
TAX STATEMENTS FOR THE REAL PROPERTY DESCRIBED
IN THIS INSTRUMENT SHOULD BE SENT TO:
Ida Beck
270 SPRING ST
Cokeville, WY 83114
and
Green Tree Servicing LLC
1400 Landmark Towers
Saint Paul, MN 55102
0857
ALAN KENT BECK 1
SIX
MALE
SOCIAL SECURITY NI sone°
AGE
57 YEARS
047E OF BIRTH
SEPTEMBER 27, 1952
BIRTHPLACE
EGLIN FORCE BASE, /FLORIDA
PLACE OF RESIDENCE
COKEVILLE, WYOMING
MARITAL STATUS AT TIME OF DEATH
MARRIED
NAME OF SURVIVING SPOUSE (If We, maiden name)
IDA MARIE PEAI2SON '1
WAS DECEDENTEVER IN
U.S. ARMED FOFiCES7
YES
FATHER NAMEt.
VERNON J BECK
BIRTHPLACE
COLORADO
MOTHER• MAIDEN NAME
AGNESA COLBIN 1
BIRTHPLACE
ALABAMA
METHOD OF DISPOSITION
REMOVAL FROM STATE
FUNERAL SERVICE LICENSEE
DAVID 4. MATTHEWS
NAME AND ADDRESS OF FUNERAL FACILITY
MATTHEWS MORTUARY, INC., MONTPELIER, IDAHO
DATE OF DEATH
DEC. 30, 2009
TIME OF DEATH
5:25 P.M.
CITY,TOWN OR LOCATION OF DEATH
POCATELLO, IDAHO`
COUNTY OF DEATH
BANNOCK
CAUSE OF DEATH (underlying cause last) Approximate Interval Between
Onset and Death
10 13 MONTH
DUE TO (or as a consequence of):
b.
DUE TO (or as a consequence
c.
DUE TO (or ass consequence of):
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH but not resulting in the underlying cause given above
NONE STATED
WAS AN AUTOPSY
PERFORMED?
NO
MANNER OF DEATH
NATURAL
NAME OF CERTIFIER
MICHAEL L. FRANCI M.D.
TITLE r
PHYSICIAN
CORONER SUBSEQUENT CERTIFICATION IF NECESSARY
DATE OF INJURY
TIME OF INJURY
PLACE OF INJURY
WORK? AT
WORK?
LOCATION WHERE INJURY OCCURRED s,
II, ''e
DESCRIPTION OF HOW INJURY OCCURRED,. i
'4T \>w
JANUARY 12, 2010
STATE OF IDAHO
DEPARTMENT OF HEALTH AND WELFARE
BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
Spate File No.
2009 -10915
Date Filed
epw
CERTIFICATION OF VITA C
VITAL RECORD
114
This is a true and'correct reproduction of the document officially registered gnd,placed
Q S$�`�� on file with the IDAHO BUREAU OF VITAL RECORDS AND HEALTH STATISTICS.
0 1
L JANUARY 12, 2010 `3 .2°7
i DATE ISSUED:
JO This copy is not valid unless prepared on engraved border JANE S. SMITH
displaying state seal and signature of the Registrar. I STATE REGISTRAR
1.
7920068n
EXHIBIT 'A'
File No.: 7920068n (mo)
Property: 270 SPRING STREET, Cokeville, WY 83114
A parcel of land in Lots 5 and 6 of Block 3 of the Dayton
Addition No. 1, a subdivision of the Town of Cokeville and Tract
90, Township 24 North Range 119 West of the 6th P.M., Lincoln
County, Wyoming, being more particularly described as follows:
BEGINNING at the Northeast corner of above said Lot 6, thence
South 31 °39'39" West, along the Easterly line to the Southeast
corner of said Lot 6, a distance of 70.49 feet;
thence South 70 °53'12" West, 64.21 feet;
thence North 52 °27'59" West, 53.30 feet to the Westerly line of
said Lot 6
thence North 31 °39'39" East, 57.04 feet along the Westerly line of
said Lot 6 to the corner common to Lots 5 and 6;
thence North 17 °34'17" East, along the Westerly line of Lot 5 (a 1
1 /2" dia. steel fence post);
thence South 78 °50'52" East, 105.53 feet to the Easterly line of
said Lot 5 (a 1 1 /2 dia. steel fence post);
thence South 17 °34'17" West, along the Easterly line of said Lot
5, a distance of 30.14 feet to the POINT OF BEGINNING.
A.P.N. 2419- 054 -08- 054.00
1111111111111111111111 BECK
47532336
FIRST AMERICAN ELS
AFFIDAVIT OF DEATH
1111 111111911 111111 1111 1 11111111 1 111 11111 1111 111
WY
WI-1PN RECORDED, RETURN 77).•
FIRST AMERICAN TITLE INSURANCE CO.
1100 SUPERIOR AVENUE, SUITE 200
CLEVELAND, OHIO 44114
NATIONAL RECORDING
1 of 1
0859